Population-wide Impact of Long-term Use of Aspirin and the Risk for Cancer.
Population-wide Impact of Long-term Use of Aspirin and the Risk for Cancer.
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DOI：
10.1001/jamaoncol.2015.6396
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发表时间：
2016-06-01
期刊：
影响因子：
28.4
通讯作者：
Chan AT
中科院分区：
文献类型：
--
作者：
Cao Y;Nishihara R;Wu K;Wang M;Ogino S;Willett WC;Spiegelman D;Fuchs CS;Giovannucci EL;Chan AT
美国预防服务工作组最近建议使用阿司匹林来预防许多美国成年人的结肠直肠癌和心血管疾病。然而，阿司匹林与其他癌症类型风险的关联，以及阿司匹林对癌症的潜在人群影响，特别是在筛查的背景下，仍然不确定。研究阿司匹林在一系列剂量和使用持续时间下对整体和亚型特异性癌症预防的潜在益处，并估计阿司匹林在筛查背景下的绝对益处。两项大型前瞻性队列研究：护士健康研究（NHS，1980-2010）和卫生专业人员随访研究（HPFS，1986-2012）。在美国，88，084名女性和47，881名男性参与了NHS和HPFS，他们每两年报告一次阿司匹林的使用。癌症发生的相对危险度（RR）和人群归因危险度（PAR）。在长达32年的随访中，我们记录了20，414例女性癌症和7，571例男性癌症。与不规律使用阿司匹林相比，规律使用阿司匹林与总体癌症风险较低相关（RR 0.97; 95% CI 0.94，0.99），这主要是由于胃肠道癌症的发病率较低（RR 0.85; 95% CI 0.80，0.91），尤其是结直肠癌（RR 0.81; 95% CI 0.75，0.88）。阿司匹林对胃肠道癌症的益处在每周至少使用0.5至1.5片标准阿司匹林片剂时明显;与较低风险相关的定期使用的最低持续时间为6年。在50岁以上的人群中，定期服用阿司匹林可以预防33例结直肠癌（PAR 17.0%），其中每10万人年有18例结直肠癌（PAR 8.5%）。定期使用阿司匹林与乳腺癌、晚期前列腺癌或肺癌的风险无关。长期服用阿司匹林与总体癌症风险（尤其是胃肠道肿瘤）的适度但显著降低相关。定期使用阿司匹林可以预防相当大比例的结直肠癌，并补充筛查的益处。
The U.S. Preventive Services Task Force recently recommended the use of aspirin to prevent colorectal cancer and cardiovascular disease among many U.S adults. However, the association of aspirin on risk of other cancer types, and aspirin’s potential population-wide impact on cancer, particularly within the context of screening, remain uncertain. To examine potential benefits of aspirin use for overall and subtype-specific cancer prevention, at a range of doses and duration of use, and estimate the absolute benefit of aspirin in the context of screening. Two large prospective cohort studies: the Nurses’ Health Study (NHS, 1980–2010) and Health Professionals Follow-up Study (HPFS, 1986–2012). Health professionals in the United States 88,084 women and 47,881 men participating in the NHS and HPFS who reported aspirin use biennially. Relative risks (RRs) for incident cancers and population attributable risk (PAR). During up to 32 years of follow-up, we documented 20,414 cancers among women and 7,571 among men. Compared with nonregular use, regular aspirin use was associated with lower risk of overall cancer (RR 0.97; 95% CI 0.94, 0.99), which was primarily due to a lower incidence of gastrointestinal cancers (RR 0.85; 95% CI 0.80, 0.91), especially colorectal cancers (RR 0.81; 95% CI 0.75, 0.88). The benefit of aspirin on gastrointestinal cancers appeared evident with use of at least 0.5 to 1.5 standard aspirin tablets per week; the minimum duration of regular use associated with lower risk was 6 years. Among individuals aged over 50, regular aspirin use could prevent 33 colorectal cancers (PAR 17.0%) among those who have not undergone a lower endoscopy and 18 colorectal cancers per 100,000 person-years (PAR 8.5%) among those who have. Regular aspirin use was not associated with risk of breast, advanced prostate, or lung cancer. Long-term aspirin use was associated with modest but significantly reduced risk of overall cancer, especially gastrointestinal tumors. Regular aspirin use may prevent a substantial proportion of colorectal cancers and complement the benefits of screening.